The Silent Killer: Stigma Toward Substance Use Disorders

As a nation we recognize we are in the midst of an epidemic with substance abuse and we have seen a year after year increase in the amount of fatalities due to drug overdose in the United States. The president, governors and community leaders everywhere have given “lip service” to the problem and have made attempts to make funds available for treatment. While the funds are definitely needed and evidence based treatment is an essential component of combating the crisis, it still doesn’t get to the root of the problem that too often prevents those afflicted from seeking treatment or getting the most effective help available. The stigma associated with substance use disorders too often leads to ineffective treatment decisions and can be a barrier for those seeking help. Stigma of the illness is potentially deadly and thus, can be said to be “the silent killer”.

Addiction is a Disease

The latest neuroscience has shown that addiction is a chronic disease just like diabetes, cancer or heart disease. Like other chronic diseases, a person typically develops a defect in a particular organ which creates a specific set of symptoms related to the abnormality and can be eventually diagnosable. For example, with diabetes, the organ defect that develops is with the pancreas. When the pancreas begins to malfunction, certain symptoms begin to emerge and eventually it can be diagnosed as diabetes. Once diagnosed, chronic diseases generally do not go away nor are they cured with medication. As in addiction, most chronic diseases also have a behavioral or personal choice component to them that can precipitate the disease. For example, smoking, obesity, drinking alcohol, lack of exercise and a poor diet all are behavioral choices that increase the risk for developing a host of chronic illnesses. These behavioral choices can lead to the development of an organ defect and ultimately a chronic disease. As a society, we generally accepted and have compassion for those who made poor choices that led to the chronic diseases of diabetes, heart disease or cancer. However, when someone with addictions engages in poor choices we often judge them, shame them or humiliate them and have difficulty showing compassion. The standards are different when it comes to addiction. Fortunately, most chronic diseases, including addictions, can be medically managed and put into remission with compliance to appropriate treatment.

The Organ Defect is in the Brain

With addictions, the organ defect is in the brain. In recent years, advances in science have proven that drugs, such as heroin and cocaine, change the brain chemistry and structure of the brain leading to serious problems with function, thinking and emotional and behavioral control. These problems often persist despite the person facing imminently harmful and self-destructive consequences. The drug “high-jacks” the brain to the point that using the drug and/or self-managing the withdrawal symptoms from the drug become the most important thing in their life. The good news is that addictions, because it is a chronic disease, can be effectively managed and placed into remission with appropriate treatment. Research has also shown that individuals with addiction who undergo treatment and abstain from further drug use, with time, usually get better and their brain chemistry, structure and function improve. Consequently, their quality of life can often be restored.

Stigma of Addiction

The stigma of addiction held by others can cause harm in several ways. I recently had a conversation with a first responder in the state who told me that their department had five recent emergency runs on a person who repeatedly overdosed on heroin. Each time, they revived the person and escorted them to the emergency room only to have them overdose again a few days later. Their comment to me was “why do we continue to rescue these people? They just use up a lot of our resources and waste our time. Why don’t we just let them die?” Another situation that has too often happened around the country is when a person who frequently relapses from their addiction, yet desires to quit, so they repeatedly show up to the ER or a facility seeking treatment. Unfortunately, after so many relapse episodes, some facilities are refusing to help these people because “you obviously are not serious about getting help and since you have not followed the recommendations you were given in the past, we will no longer admit or treat you”. They are told in so many words to “go somewhere else because we are done giving you help”. Unfortunately, this is a set up for death because people who are treated in this manner often leave and give up on seeking help, continue to use and eventually overdose and die. These responses are perfect example of how stigma can kill. Would we think this way with a person who had repeated heart attacks or someone who needed emergency attention from low blood sugar? Would we ever put a number on how many heart attacks we will allow before we will no longer treat and just let the person die? Would we refuse treatment for someone with throat cancer that had smoked their whole life and humiliate them for being a self-afflicted cancer victim? Would we refuse treatment for a heart attack victim that continued to eat high fat foods, was overweight and did not take their medications as prescribed? Of course not, because we view heart disease, diabetes and cancer as legitimate medical illnesses. Addictions are no different. Just like other chronic diseases, poor choices are involved but so are genetics, and structural changes to the brain, making it a medical condition.

Approach Addiction as a Medical Disease

When we as a society, including health professionals, begin to view addictions as a chronic brain disease, it changes the way we view the person afflicted and allows us to treat them more compassionately. Should those with addictions be absolved of negative or legal consequences to their actions? Absolutely not. People with other chronic diseases have problematic lives and legal issues too. Being compassionate and non-judgmental to someone with the chronic disease of addictions leads to better medical management and increases the likelihood of engagement of those who need to go into treatment to stabilize and repair their brain. By minimizing stigma, we are actually encouraging treatment, without shame, and thus, enhancing the likelihood that the person will be complaint and benefit from treatment. By approaching addictions as a medical disease, we decrease stigma, increase compassionate care and ultimately save lives.